Administrators within personality disorder services: their role and contribution in maintaining the overall structure and treatment approach

Abstract

Purpose People with personality disorders often present with interpersonal difficulties which affect their relationship with significant others but also with staff involved in their care. Administrators work in “frontline positions” where they are required to face challenging situations yet their role has not been studied. This study aims to describe the role and contribution of an administrator in a personality disorder service. Design/methodology/approach A mixed-methods design was used. All incoming calls to a specialist personality disorder service over three months were documented. A semi-structured focus group (n = 7) with clinicians working in the service was conducted. The data was analysed using thematic analysis. Clinical vignettes are presented to highlight typical interactions. Findings The qualitative results highlighted that the administrator is key in psychological preparations, managing pressure and maintaining clinical boundaries. Traits identified as useful in an administrator working in a personality disorder service are flexibility, consistency and assertiveness. Tensions between administrators and clinicians were related to the role definition of the administrator, boundaries, countertransference and process interaction. The majority of incoming calls were from patients scheduling and cancelling appointments. Only 3% of calls evoked negative feelings in the administrator such as feeling “annoyed” or “drained”. Practical implications Results highlight a need for careful selection, training and supervision of staff. A key recommendation is the need for integration and close coordination of the administrator within the clinical team. Originality/value This study represents one of the first efforts to explore the contribution of administrators within personality disorder services. It explores the impact of the administrator on the team.